Permit •
CITY TIGARD SEWER CONNECTION PERMIT
y;�l^r DEVELOPMENT SERVICES PERMIT #: SWR1999 -00133
" r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/21/99
SITE ADDRESS; 12955 SW WALNUT ST • PARCEL: 2S104AD -02900
1f'� N
SUBDIVISION: ONI NG: R -4.5
BLOCK: LOT: t 'JU ICTION: TIG
TENANT NAME: SELLIKEN
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Connection of existing house to sewer service. Septic tank must be pumped, filled and inspected.
Owner:
FEES
HAZEL SELLIKEN Type By Date Amount Receipt
12950 SW WALNUT
TIGARD, OR 97223 PRMT DEB 6/21/99 $2,300.00 99 -31290
INSP DEB 6/21/99 $35.00 99 -31290
Phone: 590 -4691 Total, $2,335.00
Contractor:
00,3 �R—
Phone:
Reg #:
Required Inspections
Sewer Inspection
Septic Tank Filled
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oreg *1 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You ma btain copi s of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued y: % / ,_ a, i L • Permittee Signatu
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne't business day